Klara's Guestbook

Klara Čičić  I don't take any proton pump inhibitors if that's what you mean. To protect the stomach. I have healthy stomach so I don't need to take any medications for that. Yet :)

Svetlomir Ivanov  Hey, Klara, how are you doing? By the way, do you take antibiotics before dental treatment, what kind i and what dose?

Ana Brusso  Agree with Richard. I’m sure you are very busy being a physician, mother and wife. Write when you can. 

Klara Čičić  That is so nice. I always planned to send thank you note to Germany but never did, sadly. How are you doing Richard and Ana? I started working in my office and absolutely love it now that I finished my training. My kids are well and growing and life is good. How are things in far America? Love you guys. 

Ana Brusso  Klara, so good to hear you are happy and doing well. Congratulations on your office and finishing training. Glad the kids are growing and life is good. I’m doing well and going for my Ecco on Monday. God bless you and your family. Far America is a mess. Love ❤️ and prayers 🙏

Klara Čičić  Haha far America does seem mess from down here, or it is just made look that way, media reporting only bad stuff as always...? I always like to rather hear real life people. How was your echo Ana???

Klara Čičić  Hi Svetlomir, yes I am. Some days I forget 🙈 but I try not to...baby aspirin after mitral valve repair in a younger person without risk factor is still unsolved problem, some experts are pro, some are contra and I guess the decision in the end is individual :) Take care! 

Svetlomir Ivanov  Yes, I knew that, but what is the exat logic - if, the purpose is blood thiining, sintrom is much more efective. By the way, do you have artificial chords to ancor your MV leaflets, or you surgery was just resection of the extra tissue ?

Klara Čičić  This is from UpToDate, one of the best international medical guidelines: "Limited evidence is available to guide antithrombotic therapy following surgical valve repair. Studies of patients who have undergone surgical valve repair indicate a significant risk of thromboembolism. Annuloplasty ring-associated thrombus and thromboembolism have been reported, even in patients receiving short-term anticoagulation. However, the optimum regimen to reduce the risk of thrombotic complications of valve repair has not been established.
Observational studies of patients with surgical mitral valve repair have not established a significant benefit from routine postoperative warfarin therapy compared with aspirin therapy, but the findings are inconclusive given study limitations."  I have artificial chords and a ring, no resection was made. As you can see, the brightest of minds haven't reached a consensus yet. Go with your gut and your doctor's advice :)

Svetlomir Ivanov  So do I, I have chords and ring, no resection. But exactly in this site dr.Gedrish said that after 3 months the ring is overgrown with tissue and no longer exposed to the blood. Same about the chords. I see the issue is cotraversial. May be we should ask mr.Adam Pick to interview the surgeons ? 

Klara Čičić  You can ask mr. Pick to interview them, but I don't think that we will get any different answer :)  warfarin is mandatory only the first three months after the repair. After that it is up to your cardiologist who makes the decision - warfarin,baby aspirin or nothing at all  based on known scientific evidence, on your individual history and risks.... 

Svetlomir Ivanov  Today was my 6-month control check after the operation. Aspirin was prescribed instead of sintrom for half year, but maybe permanent. But in America this is not like that, americans think that only 3-4 month after the surgery is enough

Klara Čičić  Andrew!!!!! :))) Long time no hear!!! I am doing fine, preparing for my final exam to become full GP specialist after 4 years of residency and 6 years of college! I think it is enough:))) 10 more days ....it's a huge test and huge stress. I miss my kids but study all the time.... Heart is hopefully dealing with this stress, time will show.... sometimes heavy breathing....I assume it's just anxiety from this exam. How are you, your job, your beautiful girl and wife? How are you mentally? Heart? Tell me all! 

Andrew Dial  Klara that is amazing! Wow, you have been putting your heart and soul into that, haven’t you!? You are an inspiration!! So what is your main goal in the end with your career? Heavy breathing… I’d assume that’s probably from anxiety as well. 

Things are well on my end, busy busy, as always haha. I’m building boats again, but for a different company. I’m on my feet for 10 hours a day in the cold, so I’m really putting my body thru some stuff, but I’m dealing pretty well. I have had some depression/anxiety going on, so I am on a low dose anti depressant. We will see how that goes in the coming weeks. But I am excited for better weather in the spring and then eventually summer, when we will be doing lots of camping and fishing!! Girls are good, Aubrey is in 1st grade and loving it, wifey is working her butt off as always. 

so glad to hear from you fellow heart Warrior :) 

Klara Čičić  This sounds good Andrew, I am glad you are doing the low dose antidepressants. I take anxiolytic every now and then, I am no longer trying to be "a hero", life is too short and I want to take care of my heart better so I help myself any way I can instead of suffering needlessly. Two days ago I took the final residency exam and it was brilliant, I am finally done with formal education (6 years of medical school, then 4 years of GP residency ) and now I am officially family medicine specialist (like dr. Mike haha, I guess you know who he is) on Monday I start working in my GP office... I am looking forward to that, although it isn't an easy job, it has many challenges.... Take care of your heart and be careful with it. It is harder to do that when you are young like us, I think.... And I want that hoodie, Andy! :)))

Klara Čičić  That is so valuable to hear, I always like to hear older (is that also forbidden word now?) and wiser than myself and I take notes. Trying to learn and do my best as a parent.... I have more confidence now so it is easier in that sense, but luck does play a role and by now, luck has been by our side. Your grandkids are lucky to have such a sharp and funny grandad. That is invaluable. 

Richard Munson  You sound like a great parent. The trick is to be a parent, not a best buddy. You want your kids to respect you. We are going thru it right now with shadow. As our trainer says, he will always love us but respect is what separates the good ones from the bad. 

Klara Čičić  Wow that is a good one! I agree and am trying my best to achieve just that. It's not easy, but if you have self-respect to begin with, it isn't unachievable also! :) I love parenting, just not the sleepless nights. Those were a nightmare (well, I wish there was a chance for a nightmare, but no, there was zero sleep haha).  Now that everyone sleeps it is much more enjoyable. 

Klara Čičić  I took warfarin for 4 months. I stopped after cardiac rehab, after some tests like echo and 24h holster.... Just sharply stopped and continued only beta blocker and baby Aspirin.

Klara Čičić  I am fine thank you, feeling good, no major issues. I have echo in 2 months and am already a little bit anxious....

Svetlomir Ivanov  Do not worry,one person here (Travis Watson, you may see his profile) has moderate regurfitation after mitral valve repair for 12 y., but it stay stable.I knew that, because I am corresponding with him for these 12 y.
I do not know what kind of repair is yours: resection or implantion of chords to ancor to leaflets? But probably it will last very long time or forever. Why do you presume that the MR will for sure worsen? Now you have reapir to close the gaps in the valve, and MR is just a result of the fact, that it was not watertight seal. Of course, it is better to have no MR, but read this:

https://www.heart-valve-surgery.com/heart-surgery-blog/2012/02/08/mitral-regurgitaiton-progession-craig-smith/

Klara Čičić  Oh, your words are golden for me :))) I surely hope it will last as long as you say, but I just look at it rationally, a looked at data - data shows that more complex repairs after Barlow's disease have higher chance for failure, and last shorter than simplex repair, especially when done in a younger person, which is kind of logical cause it has to endure more...

Svetlomir Ivanov  If you stay outside when raining, you have a higher chance to be struck by tunderstorm :) You are not a chance, but individual, chanses are based on statistics. By the way what is you heart rate per minute? Was it higher after surgery and for how long? Did you take beta blocker and for how long time?

Svetlomir Ivanov  Could you say, also, how long time was necessary you heart beat to normalise? How many monts, and to tell me the nimbers, i.e. your heart beats per minite before and after surgery? Waht about the beta blocker, do you continue to take it, and why (if the heart rate is normal)?

Klara Čičić  I take beta blocker bisoprolol from highschool days 1,25mg daily. My heart rate was and still is around 80-85/min. Regarding size of heart chambers, my LA was back withing normal range in 6 months after the surgery, and was enlarged before the surgery. I can not tell you exact numbers at this moment.... How are you doing? Are you off diuretics finall? 

Svetlomir Ivanov  Hi Klara, I am doiing pretty well, I am able to climb even 9th floors, of cours last floors I have to breath more deeply. No problems with walking, but still not try to running and heavy lifting. My heart rate vary, about 70-80, but on the last echo before several days, it was 95, probably because of especting results...and doc prescribe a beta bloccker, 2,5 mg. bisoprolol, but maybe 1,25 mg will be enough. But the Sintrom (bllod thinner) doc did not stop, tell me to take for  onther 3 months. Diuretics I qiut by myself because my BP is 120/80 ene even less. Of course, on the check it was 130/80, but it was measured when I was standing almost, and of course again under pressure of waiting.

Klara Čičić  It went very well! :))) very happy. Hope my heart endures it all haha. I still have 2 parts of the exam to do. 

Klara Čičić  Dear Ruth, everything is fine thank God, thank you so much for asking. Today is written part of my final residency exam so I am very very excited and hopefully I will share the good news later! I hope you and your family are fine. 

Klara Čičić  LA and LV size reduction was apparent 3-6 months after the surgery. 

I took diuretics only in the hospital for a week and that's it. My BP was always and still is low. 
I am very good thank you, cycling every other day and having no heart issues at all. I take baby Aspirin and minimal dose of bisoprolol and that's it. 

Svetlomir Ivanov  Very good news from you. But why do you take Aspirin, you do not have mechanical valve? Bisoprolol is beta-blocker for fast heart rate?

Klara Čičić  Aspirin is questionable after the repair, some cardiologists recommend it, some don't, I guess we don't have enough evidence to support it's use in everybody so doctors decide from case to case. I decided to take it, but if I don't that's also fine. Bisoprolol is a beta blocker for heart rate, I take minimal dose which I could maybe even ditch dome day :) still discussing it with my cardiologist. 

Svetlomir Ivanov  I see what are you mean, just for case, yuo are taking Aspirin. Could you remember:
1. When (which month after surgery) you get back to your normal activity without any problems like shortness of breath, fatigue, etc. ?
2. About the annuloplasty ring - is is rigid or flexible?
By the way, how are you doing, I hope MR is stable and even reduced?

Klara Čičić  I have echo next month so we will se if MR is stable, hope so! About the ring kind, si don't know. Edwards Inspiria is, I thing. I started doing normal activity without fear and symptoms 4-5 months after the surger! 

Klara Čičić  Hi Jonettee, I was just recently wondering how you are! All is well, thank God! I am studying full force for my final residency exam so that is stressful but other than that everything is well. How are you? Heart ok? Big hug from Croatia!

Klara Čičić  I saw your update post later. I don't have the exact experience with arrythmia but I can so relate to your feelings being a medical professional myself. I answered your post there. 

Klara Čičić  I took them only in hospital for water retention which is very common after surgery, for a short few days. But everyone is different and it depends on your personal history, comorbidities, your test results, physical status... maybe ask your doctor for advice.

Svetlomir Ivanov  Definitely I will ask, I am 187 cm, / 78 kg, no high BP, no watter retention, but I have been taking them already 2 weeks.

Klara Čičić  Exactly, Susan. Time flies. I am also very grateful things are the way they are. I enjoy visiting this site and be of a help to others when it ment so much to me back then... Now let's just sit back and enjoy each day that is given to us with our repaired hearts :) 

Klara Čičić  I leave that to the masters of the craft. Didn't ask whether they left mine open or they stitched it. I would assume they did it by the latest surgical recommendations...

Klara Čičić  Thank you, Marie. We have both of those available apparently. We have a lot of COVID at the moment in Zagreb, a small outbreak. 

Klara Čičić  Wow Tony, that's amazing! I am familiar with your last name and Zagreb is a small town, who knows, maybe I know her. Feel free to contact me once you come to Zagreb next year. Your story is interesting, I am sure it isn't easy bearing that burden your whole life, and especially making this decision now. I, too, am not crazy about mechanical valve and kind of hope that by the time I need a re-do they will invent something new 😂please update us on the second opinion! Pozdrav🇭🇷✌️

Antony Cikes  Hi Klara, thank you for the reply.  My mom (just in case you know her or ever get a chance to meet her) is Gordana Bjazevic. That is her maiden name. She is an incredible woman and also has an interesting story on how she left Hrvatska and now has come back.

It has been interesting growing up with heart disease as a kid.  I remember my legs would cramp up when I would try to play sports and then it got better as I grew older and when I had procedures done to help my heart. 

After my very first surgery in 1976 (I was 5 at that time) my parents gave me an action figure of Steve Austin, the 6 Million Dollar Man.  He was huge on TV back then and I used to love watching the show. With me being in hospital and hooked up to all of these devices… I thought I was the 6 Million Dollar boy and to my parents credit…. They never made me feel like there was something wrong with me.  That belief helped me growing up as there was nothing I felt that I could not do. That is the belief us congenital heart patients and patients with heart disease should have… that there is nothing we can not do.

My first valve replacement surgery was back in 2011 and at that time I had the option of a mechanical, prosthetic or ROSS approach. I was thinking ROSS but, got freaked out a bit with its complexity.  Mechanical I did not like the idea of blood work and blood thinners and with prosthetic… there was a chance that the next time it would have to be replaced, we could have other options that did not fall under open heart surgery so I went with the prosthetic valve. 

Now has come that time to replace that valve again and my cardiologist has recommended that I replace it with a mechanical valve so we don’t have to deal with another replacement in 10 to 15 years time when I would then be in my mid 60’s.

Because of me being a congenital heart patient and having a VSD, it seems like my options for a surgeon are limited to the congenital heart surgeon which, reduces the number of surgeons that are qualified to do those types of surgery.  However, I will do some more research and work on getting that 2nd opinion before I go for surgery and I am curious to hear what the surgeons thoughts are… to see if they are the same as the cardiologist. 

Will update once I know more.

Take care, ostani zdrav i neka ti srce jako kuca!  

Klara Čičić  Thank you! Things are relatively stable, I mean how stable is life itself really? :) Each day is new challenge with the kids and everything, but all in all- I don't remember last time I physically felt this good! Really. Kids and hubby are fine, thank you for asking Ana :) 

Ana Brusso  So glad to hear.  You are right, life is life. But I know we are grateful to face the challenges and resolve them. 🙏

Klara Čičić  Hi, Svetlomir. I am glad your surgery went well. I don't remember when exactly I started sleeping on my side, maybe 1-2 months... I remember using alot of pillows around me to get comfortable. I didn't wake up in the middle of the night feeling breathless, I would definitely tell that to my doctor if I were you. The only thing that woke me up was pain from damaged thoracic nerves so I took some painkillers and they got me through the night. 1km sounds really great, I wasn't able to move that much that soon! That is amazing. I took it slowly, much more slowly than you. Listen to your body and don't force anything. Your body had been through a lot. It's a huge trauma for your heart. Give it some time and increase your activity gradually. Cardiac rehabilitation program is excellent for that. You can increase your activity while being monitored and guided by experts. I recommend it wholeheartedly. I had pectoral pains for 2 months and took painkillers for it. I had breathing excercize device called incentive Spirometer but wasn't very diligent with the "lung workout". With time breathing was better by itself... Sharp pain and "stabbings" are normal and it will subside after few months, but it is all individual in the end. 

Klara Čičić  And your last question, I know my valve, haha... it was quite complex repair, and quite unusual structure. Barlow's mitral disease repair generally is more complex and has slightly worse statistics than "simplex" mitral valve prolapse, in terms of needing a re-do. Especially when done so early in life as it is in my case. Just logically, chances of this repair being "wore out" during a lifetime are higher when a person does it earlier in life that later. Thats't why I believe I will need a re-do sometime in my life. Especially because I live very active and energetic and stressed life.  Don't get me wrong, I still hope that won't be the case 😁😁 but I am also realistic and have read some data. Hope this helped and I wish you all the best in your recovery. 

Svetlomir Ivanov  Forget the data, it is deppend on your personal case. In the hospital I undergone surgery, there are publication for a man, 37 y.o., with repaired Mitral valve, he used to be triathlon runner, and now goes on with his hobby. I can you give you a site, but it is in Bulgarian, a Im afraid, you will not be able to read it. Even the opposite, after 10-20 y., this re-operation will be much easier, and probobly robotic. I am with 12 y.coresspondence with a guy (travis watson) here, and he made mitral reapir when he was 29 y.o. Same case - MR appear again after surgery, and became modderate. But he was very active sporstsmen. After that , he reduce intensiveness and after 5 y. after surgery, MR is stable and mild

Svetlomir Ivanov  By the way, when did you stop pain-killers, how long after surgery? I mean, that when I came back, a I get the same approach - many pillows, and somehow the ease my back pain, but nonetheless, sleep was very difficult. That is why, after several days , deprieved of sleep,  I took one pill of ibuprofen and slept...Yesterday again... And I can not see any use of beeing free of pain-killer, if no sleep...That is why, I am asking for your exeperience. I did two walks daily - 1,5 km. before afternoon, and 1,5 km. before a dinner, my surgery was of 14 Sept.2023. And it was relatively possible, sometime more difficult.

Klara Čičić  Wow that is a long walk, I wasn't as active as you are so early! Take it easy. Don't force it. I can not exactly remember when I stopped pain killers completely but maybe after a month and a half. Maybe. I am not sure. Maybe two months. If it helps you to sleep better, then take it. It is still early. You shouldn't get dependent on them, don't worry, just do what is best for you. You will gradually need less and less medication. 

Klara Čičić  And thanks for mentioning example of that guy. Each of us is individual and no-one knows what the cards will bring :) 

Svetlomir Ivanov  Right, no sense to tolerate pains, if could avoid them. I took twise a ibuprofen, but last night I do not need it....but sleep is difficult because of only sleeping of the back, and water pills. Klara how long did you take water pills? My bllod pressure is normal, I suppose they are just to flush my body. Probobly, becase of your children, you are overdoing, too. Arent` thete somebody to help you with them - mom, grandmom?

Klara Čičić  Yes, my mother in law is helping a lot, thank God :) I took water pills for only a short time after the surgery, maybe 10 days or so. There wasn't need for them anymore, and my BP was very low. Your doctor will know when to take you off them ...

Klara Čičić  Oh I hope it never progresses! Hello, I haven't had AFib yet (soon I will celebrate 1 year anniversary). I take baby Aspirin and bisoprolol minimal dose (1,25mg daily).

Svetlomir Ivanov  Hello, but is it necessary to take as far as you have no Afib ? I have a friend of mine, with Mitral valve repair. First months and first year after the surgery, he had moderate MR, but afterthat MR reduce to mild, maybe because of so called ''heart remodelling'' after surgery

Klara Čičić  Yes, I was hopeful this would happend to me also. We shall see. I take bisoprolol since long before the surgery, I have lots of PVCs and PACs, I guess this minimal dose of beta blocker is here as a precaution, but maybe one day I could be off of it. I wouldn't mind :)

Svetlomir Ivanov  I hope, too, that this will be the case with you. Does Maze procedure wasn`t enough to solve this problem? Or Maze eliminated Afib, but not PVSs and PACs? Does Beta blocker make you tired, and was not able to more active ot not? I mean that some exersice may be will help with PASs/PAVs, did you ever try?